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Ashok Vardhan Sundara varadhan, Astrid Fletcher, Suresh Kumar, Vinoth Kumar, Thulasiraj Ravilla; How many cataract surgeries are needed in a given population?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3799. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The usual response to above is, CSR (Cataract Surgical Rate) target, which is often based on what is feasible rather than what is needed. In real life, we need to be responsive to those who seek early intervention for cataract as well as those who are blind from it, some of whom may not be seeking care. This study is designed to estimate the annual need for cataract surgeries in a given population, reflecting this reality of what is ‘demanded’ and what is ‘needed’.
Prospective cohort design to estimate the usage of eye care services (what was demanded) and prevalence of untreated eye conditions (what needs to be addressed) in Theni district (1.2 million population).The estimated sample of 24006 subjects were enrolled from 34 clusters selected by “Cluster Randomized Sample”. Permanent residents of all ages were eligible for this study and were provided with unique ID card to track their eye care service usage over 12 months. After the 12 month period, prevalence of eye morbidity was assessed by comprehensive eye examination. Self-reported barriers were obtained through interview.Statistical methods: Usage of cataract services, blindness, and barriers were analyzed as categorical variables. Multiple logistic regression analysis using STATA 14.0 was done to find associated factors.
A subset of the sample i.e. 8516 subjects, 40 years and above alone is used in this present analysis. The mean (SD) age of the subjects was 54.1 (10.7) years and 48% were Males. Of those enrolled, 5367 subjects (63.0%) completed the eye examination. Of the 5367 subjects, 323 (6%) have approached an eye care facility for cataract and 248 (77% uptake) had undergone cataract surgery in 12 months period. Eye morbidity assessment showed 696 (13.0%) subjects as visually impaired and 9 (0.2 %) as blind due to cataract. Multiple logistic regression analysis to understand the factors associated with visual impairment due to cataract showed increasing age, lower SES, and illiteracy as significant risk factors (P<0.001 for all). The major reported barrier by the cataract blind is, lack of person to accompany them for cataract surgery (33%).
This novel study design helps in knowing the annual cataract surgery need, considering the eye care usage pattern of the population. Further statistical modelling will project the required rate of cataract services to reach Vision 2020 goals.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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